The LCP is a good concept in principle but application in practice is varied. If you are in the end of life stage with cancer then it is used very effectively to manage symptoms such as excess secretions, agitation etc. But heaven help you if you are end of life with any other condition. I know we always go on about training....... but it seems to me that if key prescribers for the medications required to initiate the pathway don't seem to understand the rationales and the benefits to patients and their families from experiencing a peaceful expected death with well managed symptom/pain control then heaven help us. (Mind you in my experience GP's are so varied in their practice, prescribing and partnership working; from being fully engaged, respecting, valueing and utilising other professionals expertise for the good of the patient, through to the clinical dinosaurs) still in their defense I guess that applies to any profession and so the question is how can it be addressed??

It seems to me that the LCP is totally reliant on good training in its implementation and excellent communication at all times and at all levels between patient, or if not possible their representatives, and all staff involved. Without this it can fail tragically.

End-of-Life behaviour and discussions definitely tends to be much more comprehensive for cancer patients than for most other patients -one possible reason is that the patients might initiate the discussions, because people tend to associate a diagnosis of cancer with 'so i'm going to die'.

But there is clearly a lot of confusion about the LCP. Nurses on this site, have stated that the LCP is 'for the final 72 hours of life': barmy, because no doctor could honestly say 'he will die in 3 dyas time, and I would be surprised if he died in 2 or 4 days time' - so '72 hours' is an absurdly precise statement, of a concept which can only meaningfully be 'last few days'.

To me, the LCP is a tool for documenting end of life care and helping to remind you to document what is going right as well as symptoms that need action. It is not an excuse to give up on care or a means to hasten the end of someones life. I would turn a palliative patient for pressure relief if I felt it appropriate for that person or not if it was not - the decision would be based on patient comfort not on whether they were on the LCP. What started as a useful tool is fast turning into something that is unusable and feared. Suddenly its a full MDT every three days to keep someone on it - why? it is not an excuse to give up but a useful means of ensuring someone receives all the care they need. Well that is how my team and I see and use it. Its a shame to loose it because, probably through lack of education it has been abused. Most of the changes in the latest version are directed towards an attitude of 'put them on the LCP and forget them'. That is surely only a minority of cases that should have been tackled with education [and probably better staffing] not with a revamp that complicates it and puts people off using it.

Anon 7.50pmThe LCP has been changed to allow moving the patient in the bed because of the number returning to health who had developed severe pressure sores.Some people on here think that the LCP is the equivalent of a firing squad and the first instruction is for stat 2 pillows applied to face till struggling discontinues. Far from it.

I agree with you and said words to the similar effect higher up but now it seems nurses are too busy or no longer considered competent to use their own clinical judgement and their skills and experience to care for their patients. What is happening?

Our patients were very well looked after without an LCP and I would hate to look after patients now with all these protocols, pathways, guidelines, etc. and living in the constant fear of making errors,even though far more seems to go wrong, or nurses and staff being accused of wrongdoing, now than ever before.

It just seems as if the media and the public are unable to accept the fact that some people in hospital will sadly die when there is no more that medicine has to offer them, as they have always done in the past.

The LCP is a tool to be used alongside good nursing care it does not replace it. I take it that most of the Anons on here have never read it, or understood the rationalé behind it. Does using a Waterlow assessment stop you turning your patients?It is not Dignitas by the back door or a cynical ploy to reduce the pensions bill ( as none of the authors have recieved a gong in the Jubille honours)

I find it awful that doctors think it's okay to accuse fellow health professionals of using the LCP to cut costs and free up beds. I hope they have some pretty good evidence to back up their outrageous and unkind claim. I should like to see their evidence.

isn't the implementation of an LCP an interdisciplinary and patient/family or representative decision? It is unthinkable that a nurse has the authority to consider such a life altering decision in isolation.

i think patients should be free to choose and decide upon their own pathway or if they are unable it should be offered them according to their personal needs. this LCP sounds too much like hocus-pocus or a conspiracy associated with this new one size fits all business which in the wrong hands is subject to misuse, serious and fatal errors and even abuse.

does this mean that those who choose not to travel along the LCP, assuming that they are given a choice in the first place, are ignored and their care neglected?

It is not universally used and sounds far to controversial and dangerous and people seem to be put on it and taken off it according to highly subjective judgements or whims of one or a few of the staff. it should be scrapped as the public and some doctors have no confidence in it whatsoever. nurses should still be trained to care for patients who are dying.

the patient protection group refused red tabards so they have the power to stand up against far more serious issues being imposed upon the public as well.

I am a bit surprised that people on the site have talked about 72 hours as end of life. We have looked at people in the last 6 months of their disease process for a definition of end of life and access to additional palliative care services; but once you have a palliative diagnosis with an incurable progressive disease then you are embarking on a journey whose length cannot be defined. There are so many variables to take into account and sometimes people are so strong mentally despite the severity of their symptoms they "do not go gently into that good night". However others are in the trough of despond and do not fight for life as you would expect. So what am I trying to articulate?? Care needs to be individualised, nurses must initiate difficult conversations using advanced communication skills so that people understand their options and can make educated choices in relation to care planning, including the initiation of the LCP. If a person and their family refuse the LCP in full understanding of the implications for symptom control and pain management and the alternative methods of treatment then surely it cannot be forced upon them!!!

It wasn't end-of-life that attracted the 72 hours comment Agent mentioned, it was the LCP. The DH regards the eol pathway as being 'the dying phase', which is probably the final few days of life: eol as a term, can also mean final year of life, etc.

Care should be discussed and planned on an individual basis, as you point out - one-size-fits-all very rarely fits well, for soemthing a complex as dying ! The problems start, if people see things like the LCP as 'rigid rules' rather than as an aid to good care.

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